ANTIRETROVIRAL DRUGS AS A PUBLIC-HEALTH INTERVENTION FOR PREGNANT HIV-INFECTED WOMEN IN RURAL SOUTH-AFRICA - AN ISSUE OF COST-EFFECTIVENESSAND CAPACITY

Objective: To estimate cost-effectiveness and capacity requirements Fo r providing antiretroviral drugs to pregnant HIV-infected women in rur al South Africa.Setting: Hlabisa health district, where HIV prevalence among pregnant women was 26.0% in 1997. Methods: Calculation of the n umber of paediatric HIV infections averted under three scenarios, and their cost. No intervention was compared with scenario A (zidovudine d elivered within current infrastructure), scenario B (zidovudine delive red through enhanced infrastructure), and scenario C (short-course zid ovudine plus lamivudine delivered through enhanced infrastructure). Co st-effectiveness was defined as cost per infection averted and cost pe r potential life-year gained. Capacity was determined in tel ms of sta ff and infrastructure required to effectively implement the scenarios. Results: With no intervention, 657 paediatric HIV infections were pro jected for 1997. In scenario A this could be reduced by 15% at a cost of US$ 574 825, in scenario B by 42% at US$ 1 520 770, and in scenario C by 47% at US$ 764 901. In scenario C, drugs accounted for 76% of co sts, whereas additional staff accounted for 18%. Cost per infection av erted was US$ 2492 and cost per potential life-year gained (discounted at 3%) was US$ 88. Cost of scenario C was equivalent to 14% of the 19 97 district health budget. At least 12 extra counsellors and nurses an d one laboratory technician, together with substantial logistical and managerial support, would be needed to deliver an effective interventi on,Conclusion: Although antiretrovirals may be relatively cost-effecti ve in this setting, the budget required is currently unaffordable. Dev eloping the capacity required to deliver the intervention would pose b oth a major challenge, and an opportunity, to improve health services. (C) 1998 Lippincott Williams & Wilkins.